Physical and sexual abuse during childhood can have long lasting consequences such as posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) is an established and effective guideline... Show morePhysical and sexual abuse during childhood can have long lasting consequences such as posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) is an established and effective guideline treatment for PTSD. Nevertheless, a considerable number of patients drop out from treatment or do not (completely) recover from PTSD during PE. It has been suggested that patients with PTSD resulting from childhood abuse are specifically at risk for suboptimal treatment outcomes. We carried out a randomized controlled trial with 149 patients with childhood abuse-related PTSD comparing PE with two innovations: intensified PE (iPE) and skills training in affective and interpersonal regulation followed by PE (STAIR+PE). We found that all treatments were safe and resulted in large improvements in PTSD symptoms. iPE and STAIR+PE did not improve treatment outcomes of PE, although iPE led to faster symptom improvements. Not all patients benefitted from the allocated treatment, but we found no contra-indications for the treatments. We found that a combination of patient characteristics was predictive of a larger effect size of PTSD symptom improvement in PE and iPE or STAIR+PE. We conclude that the three forms of exposure therapy were effective treatments for patients with childhood abuse-related PTSD. Show less
Populations in war-torn regions are exposed to a wide array of traumatic events that can cause an enormous psychological burden. Individual characteristics influence the likelihood of being exposed... Show morePopulations in war-torn regions are exposed to a wide array of traumatic events that can cause an enormous psychological burden. Individual characteristics influence the likelihood of being exposed to certain events, pointing to systematic interindividual differences in trauma exposure. However, there is a dearth of studies examining potential patterns of trauma exposure in war regions. In this cross-sectional epidemiological study, we applied a person-centered approach to identify patterns in the exposure to conflict-related traumatic events and determine their impact on commonly reported mental health problems in a population-based sample (N = 1000) from the eastern Democratic Republic of Congo. We implemented multi-stage random cluster sampling to randomly select adults from 100 villages. Of 1000 adults (Mage = 43.19 years) included in the study, 50% were female. Results showed high prevalence of PTSD (17.0%), depression (27.8%), anxiety (25.4%) and suicidality (15.1%) following exposure to conflict-related traumatic events since 2002. Latent Class Analysis identified three distinct classes of trauma exposure: Class 1 “low-trauma-exposure” (51.4%, n = 514) was characterized by the lowest probabilities of trauma exposure. Class 2 “non-physical-trauma” (39.1%, n = 391) consisted of individuals with a high probability for exposure to non-physical trauma types only. Class 3 “interpersonal-trauma” (9.5%, n = 95) had the overall highest probability of exposure to traumatic events and was the only class affected by interpersonal-trauma types. Class membership was related to gender, age and place of living. Vulnerability to mental health problems increased from low-trauma-exposure to non-physical-trauma to interpersonal-trauma class. Our findings indicate that the exposure to traumatic events in conflict-affected populations underlies distinct patterns, with interpersonal trauma as a distinguishing marker. Vulnerability to psychopathology varies with trauma patterns, revealing patterns that include both non-physical and interpersonal traumata as most detrimental for mental health. Identification of underlying trauma patterns and their effects may improve mental health care in war-affected populations. Show less
The aim of this thesis was to identify the neural mechanisms that enable a person to adaptively respond to, and recover from stress, which was studied in healthy controls, in people with increased... Show moreThe aim of this thesis was to identify the neural mechanisms that enable a person to adaptively respond to, and recover from stress, which was studied in healthy controls, in people with increased vulnerability or resilience to stress-related disorders, and in people with depression or PTSD, using magnetic resonance imaging (MRI). In most of the studies, a specific MRI method was employed, with which it is possible to assess how different brain regions communicate with each other (i.e., functional connectivity) when the brain is initiating or regulating stress responses. Structure, activity, and connectivity of the amygdala, a small brain region important for stress reactivity, was of main interest. The results show how stress influences information processing, and causes changes in the communication between brain areas, even long after the stressful event ended. Furthermore, personality dimensions associated with increased vulnerability or resilience to affective disorders were associated with changes in brain networks involved in emotion processing and regulation. Finally, smaller amygdala volumes were found in women with PTSD, while reduced integrity of affective brain networks was demonstrated in depression. Together, these results open important new avenues for future research into the short and long term effects of stress on the brain. Show less
The studies in this thesis concentrate on memory for an emotional event, with a specific focus on completeness, consistency and accuracy of emotional memories and their predictors. In doing so,... Show moreThe studies in this thesis concentrate on memory for an emotional event, with a specific focus on completeness, consistency and accuracy of emotional memories and their predictors. In doing so, both field and laboratory studies were conducted. The results show that overall, memory for emotional events is fairly complete and consistent over time. Still, the human memory is sometimes incomplete and prone to inaccuracies and inconsistencies. Maybe an elephant never forgets, people occasionally do! Emotional state, psychiatric status and psychological variables, with the exception of (peri) traumatic dissociation, did not have a strong influence on completeness, consistency and accuracy of memory for emotional events. Show less
